Lymphogranuloma Venereum (LGV)

“Lymphogranuloma Venereum (LGV)” is one of the most common STDs found in humans. Let us discuss everything about this condition and how you get rid of this ailment easily.

Lymphogranuloma Venereum (LGV)

LGV stands for lymphogranuloma venereum. A sexually transmitted disease (STD) in which small skin lesions are formed, which are often asymptomatic. It is followed by swelling of lymph nodes in the pelvic and inguinal region. The causative organism is Chlamydia trachomatis. Three unique strains of this microorganism attack the lymph nodes, which play an essential part in one’s defense mechanism against infections.

LGV occasionally occurs in the United States but is widespread in parts of South America, India, Southeast Asia, Africa, and the Caribbean. It is more frequently reported in males, commonly among homosexual and bisexual men but is also rarely seen in heterosexual men and women.

Signs and Symptoms of LGV:

There are some general and specific signs and symptoms of LGV.

General symptoms:

• Swelling of the neck, groin, and armpits
• Fever
• Rash

Specialized symptoms:

These appear in various body regions, including the rectum, genital organs, and sometimes the throat.

Rectum:

The most common site of infection by LGV, according to recent cases, is the rectum. Signs and symptoms appearing in the rectum are:

• Proctitis; inflammation in the rectum associated with pain
• Bleeding ulcers
• Constipation
• Purulent discharge
• A minor sore may appear at the entry site of bacteria into the body but is often ignored by the patients.

Genital Area:

Specific changes in the genital area of the patients affected by LGV are:

• Papules, which are bumps or raised pimples
• Swelling of the lymph glands
• Discharge and pain while urinating.
• Bleeding Ulcers

Throat:

Although LGV rarely occurs in the mouth or throat but causes swelling of the lymph glands in the neck.

Progression of LGV:

The progression of the disease occurs in three different stages. These stages are distinguished based on varying symptoms in each one.

Primary Stage

• Usually starts within 2 weeks after exposure but might take up to 30 days.
• Painless genital ulcers or papules range from 1 to 6 mm in size. Inflammation is present at the site of entry of the bacteria. Sores are also detected in the mouth and throat.
• This stage is mainly overlooked because of the lesions’ small size and generalized site. Also, any associated symptoms are absent at this stage.
• After a few days, the lesions disappear or heal on their own.

Secondary Stage

• The secondary stage, also called inguinal syndrome, appears two to six weeks after the primary stage.
• The development of buboes is the characteristic feature of this stage. These are localized swollen lymph nodes in the inguinal area, which are tender and painful.
• Inguinal lymphadenopathy is not evident in females. This is why females are not diagnosed at this stage, whereas most men present to the clinic at this stage of infection.
• General symptoms associated with this stage include fever, chills, muscle pain, and fatigue.
• If the infection is spread systemically, the following conditions appear:
  • Hepatitis
  • Arthritis
  • Pulmonary involvement
  • Cardiac involvement
  • Ocular inflammatory disease

Tertiary Stage

• Different manifestations present as syndromes depending on the route of infection.
• The anorectal syndrome occurs when the route of transmission is rectal. It is characterized by inflammation of the rectum called proctitis.
• When the transmission route of bacteria is oral, the syndrome is called an oral syndrome. Cervical lymph nodes are swollen in oral syndrome.
• Women primarily present at this stage of the infection as they lack symptoms during the previous stages.
• Pain in the abdomen, while urinating and passing stools, tenesmus, and rectal bleeding occurs. Constitutional symptoms such as body aches, headaches, and fever can be observed during this stage.

Complications of LGV:

Complications occur when the disease is left untreated. The following symptoms appear in this case:

• Necrosed and ruptured lymph nodes
• Lesions heal with scarring
• Rectal strictures
• Formation of fistulas and sinus tracts
• Gross enlargement of the genital organs, also called Elephantiasis

Who is at high risk for LGV?

The diagnosis of LGV can be difficult. Genital lesions caused by LGV are similar to those caused by other STDs such as chancroid, genital herpes, and syphilis. The symptoms related to rectal infection might be confused for ulcerative colitis.

Symptoms that are specific to LGV, i.e., vaginal ulcers, inguinal lymphadenopathy, and proctitis, are deciding criteria for a person to undergo laboratory tests. Also, patients who themselves or whose sexual partners belong to places where the infection is common are also suspected. Patients with buboes are also suspected of having LGV.

How is LGV Diagnosed?

LGV is primarily diagnosed by patients’ history, clinical presentation, epidemiology, and the elimination of differential diagnoses.

Laboratory Methods:

Bacteria from the site of infection can directly be tested for chlamydia. Even if the results for chlamydia are positive, it would not indicate if the condition is LGV. Further testing is required, which is done if the patient has rectal signs and symptoms. If a person is suspected of LGV, a sample will be taken by a healthcare provider and will be sent to local health departments to test specimens and confirm the diagnosis.

Specific lab tests available for diagnosing LGV are:

• Nucleic acid amplification testing (NAAT)
• Antibody detection

Antibodies against chlamydia or genotyping using PCR-based NAAT have been used to diagnose the disease. Antibody levels are frequently increased at the time of presentation or immediately afterward, and they usually remain elevated.

Through immunofluorescence or ELISA, direct immunoassays utilizing monoclonal antibodies to stain pus or NAATs for chlamydial antigens are available through laboratories.

Sexual partners of the patients also need to get checked. If the patient is anxious, the clinic can contact them on their behalf.

Remember that the more individuals with whom they have sex (especially unprotected intercourse), the greater the risk of their partners catching illnesses like LGV. Regular check-ups are recommended because these infections might be contracted without being aware of them.

Treatment of Lymphogranuloma Venereum (LGV):

Medications used for relieving this infection are usually antibiotics and drugs to alleviate symptoms. Oral antibiotics such as tetracycline or erythromycin are effective against the disease. Drainage of buboes is also done for symptomatic relief.

Patients should be observed for six months after apparently successful treatment.

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